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目的对行肺叶切除术、肺段切除术、肺楔形切除术的ⅠA期非小细胞肺癌患者进行生存分析,讨论肺段切除术、肺楔形切除术能否作为此类患者的常规可行术式。方法回顾性分析中国医科大学附属一院胸外科2012年1月至2015年6月474例术后诊断为ⅠA期非小细胞肺癌患者的临床资料,其中男192例、女282例,平均年龄60岁。对患者的性别、年龄、病理类型、肿瘤直径、手术方式、吸烟、饮酒、生存率、无瘤生存率及复发方式进行比较。结果肺楔形切除术患者无瘤生存率明显低于肺叶切除术及肺段切除术患者(P<0.05),肺叶切除术和肺段切除术患者无瘤生存率差异无统计学意义(P=0.789)。当肿瘤直径≤19 mm时肺楔形切除术患者无瘤生存率仍低于肺叶切除术(P=0.006)及肺段切除术患者(P=0.065),但肺楔形切除与肺段切除患者差异无统计学意义。肿瘤直径20~<30 mm的患者无瘤生存率明显低于肿瘤直径≤19 mm的患者(P=0.026)。排除肺楔形切除术患者,肿瘤直径20~<30 mm行肺叶切除术及肺段切除术患者无瘤生存率也明显低于肿瘤直径≤19 mm的患者(P=0.036)。肺楔形切除术患者局部复发风险明显高于肺叶切除术(P<0.001)及肺段切除术患者(P=0.002)。结论ⅠA期非小细胞肺癌患者行肺段切除术可获得与肺叶切除术近似生存率及无瘤生存率,特别是肿瘤直径≤19 mm的患者。肺楔形切除术作为治疗肺癌的术式尚需根据患者实际情况及手术目的谨慎选择。
Objective To analyze the survival of patients with stage ⅠA non-small cell lung cancer who underwent lobectomy, segmentectomy and pulmonary wedge resection, and to discuss whether segmentectomy and pulmonary wedge resection can be used as a routine and feasible procedure for these patients. Methods The clinical data of 474 patients with stage ⅠA non-small cell lung cancer diagnosed in the First Affiliated Hospital of China Medical University from January 2012 to June 2015 were retrospectively analyzed. There were 192 males and 282 females, with an average age of 60 year old. Patient’s sex, age, pathological type, tumor diameter, operation method, smoking, alcohol consumption, survival rate, tumor-free survival rate and recurrence were compared. Results The tumor-free survival rate of patients undergoing lung wedge resection was significantly lower than that of patients undergoing lobectomy and segmentectomy (P <0.05). There was no significant difference in the tumor-free survival between lobectomy and resection of the segment (P = 0.789 ). The tumor-free survival of patients undergoing lung wedge resection was significantly lower than that of patients undergoing lobectomy (P = 0.006) and segmentectomy (P = 0.065) when the tumor diameter was ≤19 mm, but no difference was found between patients who underwent wedge resection and segmentectomy Statistical significance. The tumor-free survival rate of patients with tumor diameters from 20 to <30 mm was significantly lower than those with tumor diameters ≤ 19 mm (P = 0.026). Excluding lung wedge resection, the tumor-free survival rate of patients with lobectomy and segmentectomy was significantly lower than those with tumor diameter ≤19 mm (P = 0.036). The risk of local recurrence in patients who underwent wedge resection was significantly higher than that in lobectomy (P <0.001) and resection of the segment (P = 0.002). Conclusions Laparotomy in stage ⅠA non-small cell lung cancer can achieve similar survival rate and tumor-free survival rate with lobectomy, especially in patients with tumor diameter ≤19 mm. Lung wedge resection as a surgical treatment of lung cancer needs to be carefully selected according to the actual situation of patients and surgical purposes.